Aortic valve surgery - minimally invasive - Overview

Definition of Aortic valve surgery - minimally invasive:

Aortic valve surgery is done to replace the aortic valve in your heart.

Blood flows out of your heart and into the aorta through a valve. This valve is called the aortic valve. It opens up so blood can flow out. It then closes, keeping blood from flowing backwards.

• An aortic valve that does not close all the way allows blood to leak back into your heart. This is called aortic regurgitation.
• An aortic valve that does not open fully will restrict blood flow. This is called aortic stenosis.

Minimally invasive aortic valve surgery is done through much smaller cuts than the large cut needed for open aortic valve surgery.

Description:

Before your surgery you will receive general anesthesia. This will make you asleep and pain-free.

There are several different ways to do minimally invasive aortic valve surgery. Techniques include laparoscopy or endoscopy, robot-assisted surgery, and percutaneous surgery.

• Your surgeon may make a 2-inch to 3-inch cut in the right part of your chest near the sternum (breastbone). Muscles in the area will be divided. This allows the surgeon to reach your heart and aortic valve.
• For the endoscopic, or keyhole, approach, your surgeon makes one to four small holes in your chest. Then your surgeon uses special instruments and a camera to do the surgery.
• For robotically-assisted valve surgery, the surgeon makes two to four tiny cuts (about 1/2 to 3/4 inches) in your chest. The surgeon uses a special computer to control robotic arms during the surgery. The surgeon sees a three-dimensional view of the heart and aortic valve on the computer. This method is very precise.

You will need to be on a heart-lung machine for all of these surgeries.

If your aortic valve is too damaged, you will need a new valve. This is called replacement surgery. Your surgeon will remove your aortic valve and sew a new one into place. There are two main types of new valves:

• Mechanical -- made of man-made materials, such as titanium or ceramic. These valves last the longest, but you will need to take blood-thinning medicine, such as warfarin (Coumadin) or aspirin, for the rest of your life.
• Biological -- made of human or animal tissue. These valves last 10 to 12 years, but you may not need to take blood thinners for life.

In some cases, you will have coronary artery bypass surgery, or surgery to replace the first part of the aorta (large blood vessel leaving the heart) at the same time.

Once the new valve is working, your surgeon will:

• Close the small cut to your heart or aorta
• Place catheters (flexible tubes) around your heart to drain fluids that build up
• Close the surgical cut in your muscles and skin

The surgery may take 3 to 6 hours.

Aortic valve surgery can also be done through a groin artery. No cuts are made on your chest. The doctor sends a catheter (tube) with a balloon attached on the end to the valve. The balloon stretches the opening of the valve. This procedure is called percutaneous valvuloplasty.

Why the Procedure Is Performed:

Aortic valve surgery is done when the valve does not work properly. Surgery may be done for these reasons:

• Changes in your aortic valve are causing major heart symptoms, such as chest pain (angina), shortness of breath, fainting spells (syncope), or heart failure.
• Tests show that changes in your aortic valve are beginning to seriously harm how well your heart works.
• Your heart valve has been damaged by endocarditis (infection of the heart valve).

A minimally invasive procedure has many benefits. There is less pain, blood loss, and risk of infection. You will also recover faster than you would from open heart surgery.

Percutaneous valvuloplasty is only done in patients who are too sick for major heart surgery. The results of percutaneous valvuloplasty are not long-lasting.